| NPI | 1164809091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 58177) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 277569) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2019-05-26 |