| NPI | 1710181490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101249923) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D66106) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2013-11-25 |