| NPI | 1780177394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101024095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315093374) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2018-06-08 |