| NPI | 1730210089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2009-01380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 29018) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-10-26 |