| NPI | 1710048004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0052586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD34105) |
| 207R00000X Internal Medicine (Licence: VA 0101056867) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-01-08 |