| NPI | 1174919153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 35674) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.35674) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2018-11-29 |