| NPI | 1558742510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D85751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209526) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2018-12-29 |