| NPI | 1225200165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101020412) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034759) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2018-03-17 |