| NPI | 1619984556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01063718A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 48389) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2021-01-21 |