| NPI | 1962474684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI 12552) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 54088) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2009-01-06 |