| NPI | 1194841254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101242709) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2007-0021) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2013-11-20 |