| NPI | 1710256615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 29354) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A48163) |
| 207R00000X Internal Medicine (Licence: GA 037213) | |
| 207R00000X Internal Medicine (Licence: AL MD22580) | |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |