| NPI | 1750543807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: GA 72075) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN12430) |
| 2085R0001X (Licence: NC 2013-01095) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2019-08-09 |