| NPI | 1114311461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 61000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2018-00364) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2020-06-11 |