| NPI | 1649279654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 37509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 24317) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2008-01-11 |