| NPI | 1922052786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 28736) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-083277) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2010-09-08 |