| NPI | 1285634436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101036169) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D29204) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2013-03-07 |