| NPI | 1942275979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9700890) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9700890) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-12-03 |