| NPI | 1306107883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101263328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.33139) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2018-01-12 |