| NPI | 1376542118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM A-1887-15) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 2385) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2015-09-28 |