| NPI | 1043505183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D79105) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2014018535) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2024-08-07 |