| NPI | 1861413551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A99941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-114210) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2009-07-14 |