| NPI | 1689960155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-00064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-248537) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2016-07-11 |