| NPI | 1134184161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 224414) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 1117) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-01-06 |