| NPI | 1154844397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 25690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 64809) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2020-05-04 |