| NPI | 1760531115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 166613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 22541) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2015-01-13 |