| NPI | 1104805803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A52642) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 028767) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2014-02-10 |