| NPI | 1811997927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 15764) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 72444) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2012-12-03 |