| NPI | 1871523100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 17068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-102128) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-09-04 |