| NPI | 1730110305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0068171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101055239) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-06-10 |