| NPI | 1629172697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR OR MD22631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD 4679) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-11 |