| NPI | 1972642973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2011-0813) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 2005-0348) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2019-12-11 |