| NPI | 1689683997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301042176) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 1667151205) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-05-12 |