| NPI | 1255498671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0067830) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 221713) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2022-09-06 |