| NPI | 1053721845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 544439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 74344) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2022-07-21 |