| NPI | 1528697976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0097802) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101279846) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2024-08-02 |