| NPI | 1912183682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101249593) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0066982) |
| Enumeration Date | 2008-01-12 |
| Last Update Date | 2013-12-23 |