| NPI | 1962693903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 37747) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT185388) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2008-07-02 |