| NPI | 1730348301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D71510) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116019648) |
| Enumeration Date | 2008-06-08 |
| Last Update Date | 2018-01-08 |