| NPI | 1174750335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD161200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 46815) |
| 207R00000X Internal Medicine (Licence: NC 2013-01586) | |
| 207R00000X Internal Medicine (Licence: MT 47189) | |
| 207R00000X Internal Medicine (Licence: ID M-16523) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2022-06-20 |