| NPI | 1013302553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D85281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 279203) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2019-08-16 |