| NPI | 1417301151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD194930) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 55225) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2021-02-05 |