| NPI | 1235490384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 28511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6705) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2017-04-17 |