| NPI | 1043320674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 12170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G52275) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-11-13 |