| NPI | 1629263504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 062003) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA TL002294) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2021-04-29 |