| NPI | 1073990099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 56007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R74962) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2021-07-29 |