| 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 |