| NPI | 1023371069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 074714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2015-01514) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2019-05-09 |