| NPI | 1831542489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 83385) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-10653) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2019-08-07 |