| NPI | 1245727791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0094904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101272653) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2022-07-07 |