| NPI | 1588638605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01034822A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 22728) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2014-09-30 |