| NPI | 1568692556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD195669) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 46310) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2020-06-01 |