| NPI | 1841584745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD214899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101257347) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2023-08-29 |