| NPI | 1568451110 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 007137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101013107) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2022-12-22 |