| NPI | 1619916087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D55475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101222995) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2021-12-29 |