| NPI | 1083956031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.207550) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2016-0175) |
| Enumeration Date | 2013-03-17 |
| Last Update Date | 2019-08-26 |