| NPI | 1336127463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 12797) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 2702) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2011-10-22 |