| NPI | 1376594531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 50535) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 13655R) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2013-02-08 |