| NPI | 1639270267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 16481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101248519) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-19 |