| NPI | 1588008213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 320446) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME129020) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2020-01-08 |