| NPI | 1114068467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-122249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 49813) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2022-04-19 |