| NPI | 1679918387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 1790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H0081803) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2018-09-23 |