| NPI | 1184187593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102207750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2022-01526) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2023-06-26 |