| NPI | 1568693067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101266766) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 45337) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2019-02-26 |