| NPI | 1619285798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD161371) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096109) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2013-11-06 |