| NPI | 1871804393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101258152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD449268) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-04-03 |