| NPI | 1326020462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-02237) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 55285) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2020-04-15 |