| NPI | 1073839312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101264080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 16498) |
| 207R00000X Internal Medicine (Licence: PA MD448405) | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2021-08-02 |