| NPI | 1679681183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 193400000X Single Specialty |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 19809) |
| 207R00000X Internal Medicine (Licence: GA 034520) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2016-06-06 |