| NPI | 1447630041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 313482) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MTL002812) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2019-07-18 |