| NPI | 1508249251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 080146) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 7616) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2018-07-03 |