| NPI | 1104092048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 071268) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME109619) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2018-06-05 |