| NPI | 1174972194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 281245) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267937) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-04-06 |