| NPI | 1003298902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 080560) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 7539) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2018-07-10 |