| NPI | 1164447884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2008032041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2006015698) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-06-10 |