| NPI | 1225117054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2012-0765) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 027536) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2016-05-20 |