| NPI | 1306826854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 20037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102201779) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2011-11-30 |