| NPI | 1609870013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 022549) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA L022549) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2015-10-06 |