| NPI | 1609897503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 00026088) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 26088) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2012-08-13 |