| NPI | 1801802863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.25171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 32192) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-08-16 |