| NPI | 1194099705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 259495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 050660) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2013-10-03 |