| NPI | 1629361340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 55229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-9018) |
| 207R00000X Internal Medicine (Licence: MS 23325) | |
| 207R00000X Internal Medicine (Licence: NM MD2019-0699) | |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2021-06-30 |