| NPI | 1821348772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD11392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME92821) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2012-09-18 |