| NPI | 1881221851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101276977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0095986) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-01-20 |