| NPI | 1912268251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 29635) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD173842) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2017-01-04 |