| NPI | 1043324171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 22779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 14748) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2013-12-16 |