| NPI | 1518944909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2008-00819) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 42236) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2011-11-30 |