| NPI | 1902939267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA VA0101037977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 43184) |
| 207R00000X Internal Medicine (Licence: IN 32011) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |