| NPI | 1609135110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS17055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS017090) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2020-10-06 |