| NPI | 1518196716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0027934) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 13188) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2015-09-16 |