| NPI | 1477616977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 231680) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT183824) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2011-05-26 |