| NPI | 1649512286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO178888) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID O-0971) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2016-09-02 |