| NPI | 1811170145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 025759) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 025759) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2015-05-18 |