| NPI | 1891888012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301028392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 052447) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-10-12 |