| NPI | 1275514028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 3537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 113318) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2020-10-06 |