| NPI | 1053467951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 246588) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD-12307) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2011-09-21 |