| NPI | 1922156579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0051963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD30444) |
| 207R00000X Internal Medicine (Licence: VA 0101058619) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-06-01 |