| NPI | 1871684118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 62287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD036953L) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-04-28 |