| NPI | 1235171885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 081610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0062141) |
| 207R00000X Internal Medicine (Licence: VA 0101237145) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-01-18 |