| NPI | 1669430955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 34153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME83125) |
| 207R00000X Internal Medicine (Licence: CA G31181) | |
| 207R00000X Internal Medicine (Licence: OR MD11024) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-11-22 |