| NPI | 1225019946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9701905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102037126) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2021-04-02 |