| NPI | 1528487048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301051717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101040886) |
| Enumeration Date | 2014-04-11 |
| Last Update Date | 2014-04-23 |