| NPI | 1679679815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 90866) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101251427) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2022-02-23 |