| NPI | 1386752806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D79919) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 26927) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-10-13 |