| NPI | 1831535517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 306579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 33813) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2021-01-27 |