| NPI | 1619924370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101230906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 202636) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2023-12-02 |