| NPI | 1821082611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 015507) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 15507) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2012-07-10 |