| NPI | 1932104015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 11759) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11759) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2020-04-13 |