| NPI | 1629076575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.12284R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 12284R) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2010-12-10 |