| NPI | 1003866633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD23660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 8057) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2020-02-02 |