| NPI | 1730191610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 37254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101229163) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2010-08-31 |