| NPI | 1578563086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD13206) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR OR13206) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2008-01-23 |