| NPI | 1164683231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.203472) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301086709) |
| Enumeration Date | 2008-06-21 |
| Last Update Date | 2015-03-31 |