| NPI | 1992233407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 85054) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009030) |
| Enumeration Date | 2017-05-28 |
| Last Update Date | 2020-06-26 |