| NPI | 1568820173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC MD36767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101053964) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2016-02-10 |