| NPI | 1114443918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 64275) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7984) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2021-09-14 |