| NPI | 1558368787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 41384) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101223311) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2015-01-14 |