| NPI | 1255366845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D68252) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD050204L) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-03-09 |