| NPI | 1992111397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01078597A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2014019449) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2017-08-01 |