| NPI | 1235546805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 54899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R74575) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2019-12-11 |