| NPI | 1457480907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD160568) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 2001-242) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2016-03-14 |