| NPI | 1649208604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-46381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 47907) |
| 207R00000X Internal Medicine (Licence: SD 1593) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2019-06-19 |