| NPI | 1609910397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 529) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5085 Temp Ed.) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2013-12-20 |