| NPI | 1407148760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A131642) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 49165) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2015-10-01 |