| NPI | 1053548545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 22631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-240222) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2022-09-13 |