| NPI | 1083716963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 21158) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 219955) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2021-08-13 |