| NPI | 1760708853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2013-00150) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 164474) |
| 207R00000X Internal Medicine (Licence: SC 87366) | |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2023-10-24 |