| NPI | 1174939482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101265181) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 390200000X) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-05-10 |