| NPI | 1245551282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS016452) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2398) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2019-10-07 |