| NPI | 1932302502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101248583) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD441893) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2017-03-24 |