| NPI | 1255674784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 82082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD457523) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2019-09-16 |