| NPI | 1023234036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201500040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 20762) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-04-01 |