| NPI | 1003812314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 35250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 21626) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2013-07-01 |