| NPI | 1720051816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042.0018391) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD032056E) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2025-03-26 |