| NPI | 1619162237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 2328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102202507) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2012-08-10 |