| NPI | 1417373754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A145647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME127087) |
| 207R00000X Internal Medicine (Licence: IN 01076391A) | |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2020-06-09 |