| NPI | 1578946117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01086014A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107352) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2021-06-24 |