| NPI | 1790763332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 60433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 41159) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2015-04-06 |