| NPI | 1013322205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 10527) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2014020084) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2019-10-31 |