| NPI | 1861757205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301116700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 72462) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2019-10-30 |