| NPI | 1801902135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 32289) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR R4696) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2012-02-17 |