| NPI | 1962599373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2001001459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 20980) |
| 207R00000X Internal Medicine (Licence: PA MD066618L) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-07-08 |