| NPI | 1689660672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 29854) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 14812) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2016-01-25 |