| NPI | 1104209402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 007712) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO4613) |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2021-08-06 |