| NPI | 1871518225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 34589) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.14958R) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2016-01-04 |