| NPI | 1356440093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 114510) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 279203-1205) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-08 |