| NPI | 1306820667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR 153579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01059242A) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-11-16 |