| NPI | 1184612889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2005036210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 028356) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2007-07-08 |