| NPI | 1568579936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 43221) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-103235) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2012-03-30 |