| NPI | 1497019210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D91111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 005664) |
| 207R00000X Internal Medicine (Licence: GA 074275) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2022-03-09 |