| NPI | 1720068992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101233071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD30938) |
| Enumeration Date | 2006-01-22 |
| Last Update Date | 2011-12-14 |