| NPI | 1104988054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0040216) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD14432) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-08 |