| NPI | 1982717765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D65008) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101240453) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2018-06-19 |