| NPI | 1023297397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2007-01772) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 40101) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2019-06-19 |