| NPI | 1962522680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 37838) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT pending) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2021-04-20 |