| NPI | 1063732121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 17085) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.058160) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2015-09-11 |