| NPI | 1194916445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 57006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301090168) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2014-07-07 |