| NPI | 1891868196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD 036091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD13670) |
| 207R00000X Internal Medicine (Licence: VA 0101043015) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2011-12-06 |