| NPI | 1417906520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9900524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 99-00524) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2010-04-08 |