| NPI | 1073654976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D81266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 057556) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2022-03-09 |