| NPI | 1073651006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101054555) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D48342) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2021-11-22 |