| NPI | 1255620597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 83356) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD042397) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2022-01-04 |