| NPI | 1972661312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102202065) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH RT 4889) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-08-17 |