| NPI | 1023273273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 12834) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 049949) |
| 207R00000X Internal Medicine (Licence: ND PT 12834) | |
| Enumeration Date | 2008-07-26 |
| Last Update Date | 2013-10-10 |