| NPI | 1295020618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 9224) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 55228) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2019-10-31 |