| NPI | 1205100518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC 217045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116024305) |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2012-03-05 |