| NPI | 1609856897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301072463) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 4301072463) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2020-10-22 |