| NPI | 1750376513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS9241) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL FLOS9241) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2021-08-18 |