| NPI | 1316922685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301074380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0097352) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2021-03-22 |