| NPI | 1609033265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-12091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2008-0049) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2020-09-23 |