| NPI | 1003850611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301057790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 40857) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-12-19 |