| NPI | 1649387697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-34793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 34793) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2015-01-15 |