| NPI | 1629273594 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD155792) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R8075) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2012-01-12 |