| NPI | 1811945694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 253918) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI ri11798) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-02-20 |