| NPI | 1477074995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101269436) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2017023366) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2020-06-30 |