| NPI | 1396861332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 28360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL 27036) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2011-07-11 |