| NPI | 1740693696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 83708) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5151010877) |
| 207R00000X Internal Medicine (Licence: MI L283875) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-07-21 |