| NPI | 1629177068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042.0013293) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD041176E) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-12-29 |