| NPI | 1124072780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 230890) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 038009) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-07-09 |