| NPI | 1902898679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 30136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 11802) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2020-09-09 |