| NPI | 1740280288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-02565) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 223285) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2021-11-29 |