| NPI | 1396151148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1033) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101021126) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2017-12-31 |