| NPI | 1386741395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101056404) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0054223) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-03-04 |