| NPI | 1396298022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 19532) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267908) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2019-08-27 |