| NPI | 1801864764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 31365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 11046) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2013-11-20 |