| NPI | 1710906128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 32022) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 69030) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-06-02 |