| NPI | 1780066217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 30731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7458) |
| Enumeration Date | 2015-06-21 |
| Last Update Date | 2018-06-19 |