| NPI | 1164467775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9300246) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 35302) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2017-12-26 |