| NPI | 1487681862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-02710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 20199) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2019-11-19 |