| NPI | 1740331099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 313185) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS MS17625) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2020-01-23 |