| NPI | 1679505739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 15317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL DO450) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-04-14 |