| NPI | 1053359174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 36053) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301077534) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-07-31 |