| NPI | 1972591550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC DO31453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102050256) |
| Enumeration Date | 2005-10-08 |
| Last Update Date | 2018-05-29 |