| NPI | 1942567730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2016016331) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-9842) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2016-07-11 |