| NPI | 1982627519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101258837) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01062502A) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-08-08 |