| NPI | 1528040623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 33863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101252860) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2017-12-13 |