| NPI | 1205371226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA ML61546026) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101270256) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2024-06-26 |