| NPI | 1992864433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD036400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0065086) |
| 207R00000X Internal Medicine (Licence: VA 0101240111) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2021-08-11 |