| NPI | 1477598126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME29107) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR C4970) |
| 207R00000X Internal Medicine (Licence: CO DR42017) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-07-08 |