| NPI | 1407904428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2018-02846) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 51873) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-09-25 |