| NPI | 1235197153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 1278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 158549) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2014-10-28 |