| NPI | 1063578060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101057630) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D54095) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2023-11-27 |