| NPI | 1194165639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA DO-04933) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-9810) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2023-01-05 |