| NPI | 1659462083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 238221) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A89138) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-08-01 |