| NPI | 1265728281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-01649) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 4868) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2021-03-10 |