| NPI | 1538167119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 58980) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 22746) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2020-01-22 |