| NPI | 1801887781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101044535) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0037566) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-10-03 |