| NPI | 1649285107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301501108) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 2004-0332) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-01-07 |