| NPI | 1699749564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 23784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 26196) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-09-03 |