| NPI | 1083613749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2020-00922) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 106466) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2024-01-30 |