| NPI | 1396832853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2015-00172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 205017) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2016-02-17 |