| NPI | 1356519961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 257180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS014196) |
| Enumeration Date | 2008-02-16 |
| Last Update Date | 2014-05-02 |