| NPI | 1134508104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS14669) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO4359) |
| Enumeration Date | 2015-05-24 |
| Last Update Date | 2019-03-20 |