| NPI | 1528025517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101-249322) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 20872) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2014-12-24 |