| NPI | 1164788675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 82590) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D79188) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2020-05-19 |