| NPI | 1144205253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 12563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 35915) |
| 207R00000X Internal Medicine (Licence: NC 38466) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2020-01-23 |