| NPI | 1235411463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19,011) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 28436-R) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2015-10-07 |