| NPI | 1063617603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A97693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50188) |
| 207R00000X Internal Medicine (Licence: MI 4301092458) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2011-03-22 |