| NPI | 1740711241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101280687) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 20140) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2024-01-16 |