| NPI | 1215919261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2015-0605) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200301178) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2015-09-17 |