| NPI | 1154370542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301114546) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 42920) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2020-01-13 |