| NPI | 1174615157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01028799) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01028799A) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-09-05 |