| NPI | 1679643712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA GA056459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME88508) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2018-04-24 |