| NPI | 1922270644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116017379) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101243395) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2009-01-06 |