| NPI | 1215010202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 40945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD07267L) |
| 207R00000X Internal Medicine (Licence: CA G73153) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-05-26 |