| NPI | 1114978897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 3095263-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 02525) |
| 207R00000X Internal Medicine (Licence: VA 0101021971) | |
| 207R00000X Internal Medicine (Licence: CA G34230) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |