| NPI | 1093754590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 65250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-109804) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-08-12 |