| NPI | 1962644120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 157128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 34353) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2019-02-19 |