| NPI | 1568444321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 17956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30130) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2020-09-03 |