| NPI | 1154681310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 38744) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 005447) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2015-11-04 |