| NPI | 1205820057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.32090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200000422) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2018-03-29 |