| NPI | 1255746426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS14816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116027337) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2019-05-21 |