| NPI | 1821351800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 64040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116025046) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2015-07-08 |