| NPI | 1093166050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 31549) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7687) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2019-07-25 |