| NPI | 1578546941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0087924) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101238060) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2021-06-16 |