| NPI | 1942512173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 32692) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL32692) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2021-04-23 |