| NPI | 1003893330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301405760) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-7300) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2019-09-09 |