| NPI | 1316125008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2006-01682) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 49385) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2017-07-21 |