| NPI | 1053365908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 25943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 0043232) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2009-11-25 |