| NPI | 1942382460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 21182) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R7907) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2008-09-24 |