| NPI | 1316964364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 23955) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 10266) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-01-03 |