| NPI | 1871906628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 36921) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL36921) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2018-08-02 |