| NPI | 1417076290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 061500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 0000050726) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2015-02-03 |