| NPI | 1649362138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9500577) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 95-00577) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2019-08-22 |