| NPI | 1073663829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0041072) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD17158) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2011-12-05 |