| NPI | 1336569904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02005562A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 3196) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2022-10-15 |