| NPI | 1376535872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101243335) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200400524) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2014-12-12 |