| NPI | 1659509149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 26128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5982) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2012-08-10 |