| NPI | 1063577310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D20367) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD7229) |
| 207R00000X Internal Medicine (Licence: VA 0101035431) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-01-08 |