| NPI | 1346258464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101240113) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD065203L) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2009-12-29 |