| NPI | 1225138456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 075324) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 112571) |
| 207R00000X Internal Medicine (Licence: IL 036.135303) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-03-31 |