| NPI | 1366738692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 14768) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 267354) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2013-08-30 |