| NPI | 1639561442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102208699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS022373) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2025-01-24 |