| NPI | 1134130735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 150516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 9895) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |