| NPI | 1730374075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD163154) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50875) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2019-01-10 |