| NPI | 1407054976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-02990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 4693) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2021-12-08 |