| NPI | 1558682583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0079224) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 254879) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2016-03-04 |