| NPI | 1396981361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101246509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 150204) |
| 207R00000X Internal Medicine (Licence: MD D73365) | |
| 207R00000X Internal Medicine (Licence: NC 2011-01769) | |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2013-04-25 |