| NPI | 1639140775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-02009) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 23630) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2012-01-13 |