| NPI | 1962606103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 202536) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036117268) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2012-04-18 |