| NPI | 1912174814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD27418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A74652) |
| Enumeration Date | 2008-05-11 |
| Last Update Date | 2008-05-11 |