| NPI | 1801076419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101248655) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0070617) |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2022-02-07 |