| NPI | 1336472422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301093625) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 52339) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2009-09-08 |