| NPI | 1851314132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020038381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 364430-1205) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-01-08 |