| NPI | 1629497615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 12645) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101259040) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2021-08-04 |