| NPI | 1639432644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 35388) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL34860) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2016-09-12 |