| NPI | 1942217989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 31892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 87-236) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2019-07-10 |