| NPI | 1538128863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101049197) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101049197) |
| 207R00000X Internal Medicine (Licence: WV 17223) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2010-01-27 |