| NPI | 1386638732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101232890) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 36582) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2019-08-12 |