| NPI | 1336428580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR T2011-082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101250686) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2021-01-25 |