| NPI | 1730563644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01081096A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108412) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2018-12-12 |