| NPI | 1538553433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301117436) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315204924) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2019-04-09 |