| NPI | 1457345902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2000-01479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 020688) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2013-02-22 |