| NPI | 1053348771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 12651) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 21171) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2019-11-05 |