| NPI | 1093154254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015018622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2013018432) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2021-02-15 |