| NPI | 1689861635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101257744) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2007-01198) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2018-06-29 |