| NPI | 1790749109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101277071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME81418) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-02-24 |