| NPI | 1962449942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101273192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D37606) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-11-21 |