| NPI | 1700178597 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02004160A) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204458) | 
| Enumeration Date | 2011-05-11 | 
| Last Update Date | 2022-06-03 |