| NPI | 1043402480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 1658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT012273) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2022-01-27 |