| NPI | 1760475859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 1546) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS005031L) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2020-10-29 |