| NPI | 1639510019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D80462) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P28831) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2023-03-30 |