| NPI | 1154524734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-10048) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 345903-1205) |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2020-04-13 |