| NPI | 1396866380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5250) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2012-10-23 |