| NPI | 1952386989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101033664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-00846) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2021-04-13 |