| NPI | 1497169296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 83079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-9873) |
| 207R00000X Internal Medicine (Licence: MO 2014018329) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2021-07-29 |