| NPI | 1023055290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM 2021-1051) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 0000028293) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2022-10-28 |