| NPI | 1588089106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0079970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN HD0000053205) |
| 207R00000X Internal Medicine (Licence: WA MD60803160) | |
| 207R00000X Internal Medicine (Licence: MA 263449) | |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2020-10-15 |