| NPI | 1023063732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301060345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50901-020) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2024-03-07 |