| NPI | 1962766006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301113900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0078843) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2021-02-25 |