| NPI | 1821264425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D80017) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 23614) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2022-03-09 |