| NPI | 1659523991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 40598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2013-01115) |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2024-03-23 |