| NPI | 1952377004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2011-0698) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 81827) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2011-10-18 |