| NPI | 1871552406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2007-00657) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0057796) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2007-11-02 |