| NPI | 1134568421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201600420) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116026094) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2020-10-25 |