| NPI | 1194952200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 38963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 390200000X) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2018-04-30 |