| NPI | 1861447625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2004018570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R1P90) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2015-08-06 |