| NPI | 1861806366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201701227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116026996) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2022-07-21 |