| NPI | 1780034090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301118983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068764) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2019-07-16 |