| NPI | 1215903885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 265240) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD062638L) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2016-02-08 |