| NPI | 1487097028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 31337) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 54656) |
| Enumeration Date | 2013-04-13 |
| Last Update Date | 2023-03-16 |