| NPI | 1811098940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101042048) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 11179) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-04-03 |