| NPI | 1790734952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 20266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 109735) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2016-01-12 |