| NPI | 1801989512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR C-8165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 8664) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-10-26 |