| NPI | 1174569180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101238007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD DD66837) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2022-06-02 |