| NPI | 1992112304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME129654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105141) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2019-04-16 |