| NPI | 1720004393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 40421) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 38813) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2014-01-02 |