| NPI | 1548367923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00046667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 52015) |
| 207R00000X Internal Medicine (Licence: VA VA 0101044019) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-08-29 |