| NPI | 1104826619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A76554) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A76554B) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2013-04-25 |