| NPI | 1205180049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301058415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 53155048724) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-11-01 |