| NPI | 1740543180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101021450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL0899) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2017-05-01 |