| NPI | 1639121841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301080609) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI MK080609) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-02-28 |