| NPI | 1669741575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 49828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301099692) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2021-08-06 |