| NPI | 1316235906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101260070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 201401636) |
| Enumeration Date | 2011-07-16 |
| Last Update Date | 2023-07-24 |