| NPI | 1386056158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0083523) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101262050) |
| 207R00000X Internal Medicine (Licence: PA MT206997) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2021-12-07 |