| NPI | 1629459904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 1.060415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107096) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2018-06-26 |