| NPI | 1588936546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301111879) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 250782) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2021-07-07 |