| NPI | 1073596458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME71472) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 34064) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2020-08-28 |