| NPI | 1538165741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 14405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 14081) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2008-12-11 |