| NPI | 1851378012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 34214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME105681) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-03-01 |