| NPI | 1003891813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101244352) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301069282) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2019-04-26 |