| NPI | 1174545891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 36647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 49311) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2014-07-03 |