| NPI | 1902884703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-55424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 41973) |
| 207R00000X Internal Medicine (Licence: NM MN2014-0783) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2017-07-02 |