| NPI | 1174810295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 50877) |
| 207R00000X Internal Medicine (Licence: IL 125059070) | |
| Enumeration Date | 2011-07-10 |
| Last Update Date | 2021-06-03 |