| NPI | 1205886090 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR N-8080)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR N8080)  | 
| Enumeration Date | 2006-05-11 | 
| Last Update Date | 2018-02-16 |