| NPI | 1548450638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2011-01460) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 232368) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2022-11-30 |