| NPI | 1871506386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 025604) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2016-01385) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2022-01-06 |