| NPI | 1457559346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 25627) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5645) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2019-10-15 |