| NPI | 1508904541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101057952) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D55131) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2021-06-06 |