| NPI | 1932129095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 056135206) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 011873) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-08-15 |