| NPI | 1619062114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD18342) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD18342) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-04-06 |