| NPI | 1134713340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101277087) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101277087) |
| Enumeration Date | 2021-02-28 |
| Last Update Date | 2024-12-22 |