| NPI | 1568605319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.34552) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.204369) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2020-11-12 |