| NPI | 1598764524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 22099) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 051431) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2021-05-12 |