| NPI | 1982124889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 281600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272374) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2020-06-28 |