| NPI | 1073810537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-01773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-9791) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2021-04-10 |