| NPI | 1205115359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-01677) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 198530) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2020-09-10 |