| NPI | 1922045939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C 55122) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 74864) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2013-05-22 |