| NPI | 1720179682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 40121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 030725) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-05-25 |