| NPI | 1508092933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 12406) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN13792) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2012-09-12 |