| NPI | 1437159688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102201644) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201644) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2022-03-22 |