| NPI | 1982997557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 266025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301 098 213) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2019-05-15 |