| NPI | 1205092921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 64660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.121020) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2015-08-04 |