| NPI | 1154624427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 66482) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 33900) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2022-06-15 |