| NPI | 1093966418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2015-0648) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD156270) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2015-12-07 |