| NPI | 1871710467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 42118) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088117) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-09-29 |