| NPI | 1902963945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 028787) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0058384) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |