| NPI | 1396745535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-00994) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101047046) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2020-10-27 |