| NPI | 1003073685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101277337) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 228391) |
| 207R00000X Internal Medicine (Licence: PA MD436675) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-12-28 |