| NPI | 1609912351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101243032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD026275) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2013-04-08 |