| NPI | 1093717837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2015-1230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 043096) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2022-07-21 |