| NPI | 1306883970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 37695) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R2J99) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2021-04-23 |