| NPI | 1871791434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 20650) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS T-1983) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2019-02-26 |