| NPI | 1780061812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO187639) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 172258) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2020-11-06 |