| NPI | 1639584915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 29741) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7310) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2017-03-03 |