| NPI | 1790705796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 35605) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200000236) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-09-21 |