| NPI | 1366510778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD30620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0052433) |
| 207R00000X Internal Medicine (Licence: VA 0101057408) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-11-25 |