| NPI | 1174589501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301073838) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 17917) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2013-12-11 |