| NPI | 1811007966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 9764) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 38145) |
| 207R00000X Internal Medicine (Licence: TN 45694) | |
| 207R00000X Internal Medicine (Licence: MN 42291) | |
| 207R00000X Internal Medicine (Licence: ND 12805) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-02-26 |