| NPI | 1245212893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301098767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01053431A) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2015-02-18 |