| NPI | 1982677183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 38073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200801283) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-11-16 |