| NPI | 1912080144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 024908) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS MS19412) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2009-12-23 |