| NPI | 1902130891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 243569) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 241559) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2011-03-01 |