| NPI | 1649241902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 059974) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 20274) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2021-11-01 |