| NPI | 1699778662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 22862) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 24418) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-11-06 |