| NPI | 1679548291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2013-01966) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 45493) |
| 207R00000X Internal Medicine (Licence: WV 22102) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-03-26 |