| NPI | 1558331033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 19307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101044245) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2012-07-27 |