| NPI | 1780989418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA DO.000365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2521) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2014-12-29 |