| NPI | 1720085681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2008-01344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 15680Rl) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2009-07-29 |