| NPI | 1699725713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 40352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 18775) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2008-06-16 |