| NPI | 1700224201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2018022314) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA DO-04881) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2018-09-04 |