| NPI | 1356306609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01041381A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 29515) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2014-11-10 |