| NPI | 1861452765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD153836) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 31445) |
| 207R00000X Internal Medicine (Licence: AZ 31447) | |
| 207R00000X Internal Medicine (Licence: NM MD2010-0738) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-12-22 |