| NPI | 1992702112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0058853) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101242050) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2018-12-26 |