| NPI | 1114245800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101254861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116023029) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2021-08-23 |