| NPI | 1043284458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 94-00481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 84130) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-07-30 |