| NPI | 1316251010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301095837) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 51709) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2021-03-26 |