| NPI | 1457646085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 85601) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC MMD.33625 LL) |
| 207R00000X Internal Medicine (Licence: NC 2014-01498) | |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2020-05-11 |