| NPI | 1457799017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO178199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG163140) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-03-15 |