| NPI | 1295185809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 82724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL39529) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2019-06-03 |