| NPI | 1306005665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101245698) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA TMD005195) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2020-11-04 |