| NPI | 1952784381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 310358) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108241) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2021-10-25 |