| NPI | 1649402876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101252049) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301094476) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2025-03-05 |