| NPI | 1124339593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 60443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.058091) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-04-01 |