| NPI | 1063483188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101246993) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 228846) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-11-13 |