| NPI | 1700017399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL UO2217) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 03457) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2022-01-25 |