| NPI | 1548498744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 28343) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D73842) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2015-07-21 |