| NPI | 1356372668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 31519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 017179) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-04-04 |