| NPI | 1558662700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 3333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H80359) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2021-09-28 |