| NPI | 1548245855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101247752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 30149) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2015-11-05 |