| NPI | 1508878638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A105940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 044665) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2012-06-21 |