| NPI | 1881013118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 3129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204981) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-04-08 |