| NPI | 1609415736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101279093) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116033707) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2023-10-25 |