| NPI | 1992149801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 301813) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.34049) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2021-05-26 |