| NPI | 1477737740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101258587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD433280) |
| Enumeration Date | 2007-12-22 |
| Last Update Date | 2020-03-19 |