| NPI | 1104994631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301073836) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 11106A) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-01-23 |