| NPI | 1922450246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301110744) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315077927) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-07-11 |