| NPI | 1992774434 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 030634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 030634) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2013-08-07 |