| NPI | 1629146030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR 156720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D71696) |
| 207R00000X Internal Medicine (Licence: VA 0101237268) | |
| 207R00000X Internal Medicine (Licence: DC MD35245) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-11-03 |