| NPI | 1326468851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 76374) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200918) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2019-07-18 |