| NPI | 1356617518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 9218046-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRO-1274) |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2015-09-22 |