| NPI | 1356345797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01062740A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301074457) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2009-12-17 |