| NPI | 1487624573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 8690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 36592) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2014-05-13 |