| NPI | 1730164419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2000-01281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 27506) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2016-09-26 |