| NPI | 1346561040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 006187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-8981) |
| 207R00000X Internal Medicine (Licence: IA 4340) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2022-10-20 |