| NPI | 1366763070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 069624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 4151) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-01-03 |