| NPI | 1174541874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 60970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 29533) |
| 207R00000X Internal Medicine (Licence: ND 9791) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-02-09 |