| NPI | 1053440719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D19693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD19304) |
| 207R00000X Internal Medicine (Licence: VA 0101230602) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2011-11-23 |