| NPI | 1487762084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 035609) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 19812) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-07-31 |