| NPI | 1194883538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9900516) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 562234742) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2009-07-06 |