| NPI | 1205197464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 28491) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6702) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2018-07-03 |