| NPI | 1003913526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 17416) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2007-000516) |
| 207R00000X Internal Medicine (Licence: CT 62579) | |
| 207R00000X Internal Medicine (Licence: SC 21385) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2024-03-12 |