| NPI | 1760898993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 30338) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7352) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2017-09-12 |