| NPI | 1902089725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201500821) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 6804162-1205) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2015-07-31 |