| NPI | 1164801098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2018-02169) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 85218) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-03-03 |