| NPI | 1699715011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 16224) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 22885) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-04-02 |