| NPI | 1710561238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101282010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0100551) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2024-06-11 |