| NPI | 1679894752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A137968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101253922) |
| Enumeration Date | 2010-06-12 |
| Last Update Date | 2015-09-30 |