| NPI | 1972736023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01082301A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200801438) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2019-07-16 |