| NPI | 1851703086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-44177) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-09954) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2017-04-09 |