| NPI | 1689129702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301500220) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI AP2742713-356) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2019-07-09 |