| NPI | 1770764128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 38813) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-120602) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2021-06-03 |