| NPI | 1629157763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0072684) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101250271) |
| 207R00000X Internal Medicine (Licence: DC MD039528) | |
| 207R00000X Internal Medicine (Licence: CA G83494) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2021-05-30 |