| NPI | 1497915235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101249166) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 25288) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2022-10-14 |