| NPI | 1659310704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD164287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 039504L) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2019-12-20 |