| NPI | 1134413370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 43663) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME126112) |
| 207R00000X Internal Medicine (Licence: MA 258954) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2022-04-07 |