| NPI | 1306890538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA ME155295) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101237505) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2024-10-25 |