| NPI | 1518997188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2005-01961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 054871) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2018-03-17 |