| NPI | 1649488008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 201660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA G02044) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-10-24 |