| NPI | 1376746339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D67581) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD040758E) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2008-10-08 |