| NPI | 1639118409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 24435) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 24435) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2008-05-22 |