| NPI | 1801081245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD 204227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 13641) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2020-05-10 |