| NPI | 1710087614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC MD37591) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 028267) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-06-10 |