| NPI | 1962590539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 14686) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 14686) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-10-20 |