| NPI | 1497286363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 86053) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009120) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-01-19 |