| NPI | 1548649163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS15227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101021576) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2020-01-09 |