| NPI | 1497910186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 66113) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD20110485) |
| 207R00000X Internal Medicine (Licence: PA MT193304) | |
| 207R00000X Internal Medicine (Licence: MN 62991) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2022-10-04 |