| NPI | 1720340144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2015-00323) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 183271) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2023-01-25 |