| NPI | 1780687715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101025154) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101025154) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2016-06-02 |