| NPI | 1083668636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 20071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 12688) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2016-08-15 |