| NPI | 1558522482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS11207) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT012726) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2018-08-28 |