| NPI | 1629058599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM NM2013-0849) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301074075) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2023-07-21 |