| NPI | 1912916479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2006024382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-3423) |
| 207R00000X Internal Medicine (Licence: OK 18409) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2013-01-21 |