| NPI | 1790983443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI OA091111) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: VA 0101238614) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2017-05-17 |