| NPI | 1922055722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 62134) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 30591) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2021-01-10 |