| NPI | 1265127864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101056980) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 216031) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-10-07 |