| NPI | 1548748957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 146344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 33804R) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2020-07-24 |