| NPI | 1720191596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD23194) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 8426) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-02-04 |