| NPI | 1891799433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9600538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 20605) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2020-10-30 |