| NPI | 1548796543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101025436) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101023043) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-03-17 |