| NPI | 1477560944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101249878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34841) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-11-03 |