| NPI | 1447291109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-9514) |
| Additional Taxonomies | 174400000X Specialist (Licence: MT 9514) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2021-05-10 |