| NPI | 1255713871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015017907) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01080176A) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-01-25 |