| NPI | 1831484765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 33654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL33654) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2020-11-04 |