| NPI | 1932162641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101240943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200301002) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2015-07-10 |