| NPI | 1184776049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D41240) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 20499) |
| 207R00000X Internal Medicine (Licence: VA 50112) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2010-11-16 |