| NPI | 1083827018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101241559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD433581) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2013-11-19 |