| NPI | 1770017691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101273728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D89192) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2022-12-30 |