| NPI | 1548230287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C55423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0430798) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2012-11-02 |