| NPI | 1679567341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO224) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 051097) |
| 207R00000X Internal Medicine (Licence: OH 4395) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2007-07-09 |