| NPI | 1164488805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301104623) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 72339) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2019-12-12 |