| NPI | 1063701035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 16342A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2013-01839) |
| 207R00000X Internal Medicine (Licence: VA 101263371) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2024-02-22 |