| NPI | 1649438052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 30780) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL30780) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2020-12-15 |