| NPI | 1760876080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 51926) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 208733) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2020-12-08 |