| NPI | 1336473495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 54690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 44999) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2023-05-08 |