| NPI | 1831146786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101051866) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD046333L) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2023-01-11 |