| NPI | 1780117382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 60210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76051) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2020-07-01 |