| NPI | 1609989474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD183376) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME87189) |
| 207R00000X Internal Medicine (Licence: NC 2015-00137) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2018-09-27 |