| NPI | 1629053277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 052184) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 39951) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2019-11-01 |