| NPI | 1356447528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO.1567) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA-463) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2019-06-28 |