| NPI | 1881983385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101264733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.205588) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2018-06-15 |