| NPI | 1861630907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01072237A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 29446) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2019-05-28 |