| NPI | 1528088937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C129586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 227845) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-07-10 |