| NPI | 1104864172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101034376) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 20427) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2012-01-03 |