| NPI | 1598866402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0041123) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101053484) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |