| NPI | 1164866968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301103729) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01081340A) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2020-12-23 |