| NPI | 1588604573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301500426) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2004019698) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-01-22 |