| NPI | 1457345605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 040311) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 154284) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2010-02-16 |