| NPI | 1154314326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0056934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0056934) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2010-01-12 |