| NPI | 1821313966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AZ 49151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 16525451921) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2015-01-20 |