| NPI | 1841356953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0057818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101040260) |
| 207R00000X Internal Medicine (Licence: CA GFE57956) | |
| 207R00000X Internal Medicine (Licence: PA MD428951) | |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2007-07-08 |