| NPI | 1376683680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101046513) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D37657) |
| 207R00000X Internal Medicine (Licence: DC MD30091) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |