| NPI | 1184793457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD 5331) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101022176) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |