| NPI | 1396977062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2012020489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO T2009011772) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2013-01-21 |