| NPI | 1922411537 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 077724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL36700) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2021-01-29 |