| NPI | 1275823882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2011-01419) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251149) |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2021-04-13 |