| NPI | 1871574525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R8E05) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 24734) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2011-12-08 |