| NPI | 1851742712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-12235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 0000000000) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2019-06-05 |