| NPI | 1992759088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 25425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 36156) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2008-01-22 |