| NPI | 1871546358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD H53939) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 42908) |
| 207R00000X Internal Medicine (Licence: IA 3306) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-10-19 |