| NPI | 1487883740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101251159) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 003711) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2021-05-10 |