| NPI | 1215111414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA 064571) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 064571) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2013-03-01 |