| NPI | 1295963338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 15460) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2003025922) |
| 207R00000X Internal Medicine (Licence: OR MD150108) | |
| 207R00000X Internal Medicine (Licence: ND PT 12927) | |
| Enumeration Date | 2009-06-28 |
| Last Update Date | 2013-08-31 |