| NPI | 1720146152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR 25322) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR do25322) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2009-11-12 |