| NPI | 1083637805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GU M-2010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT181128) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-10-15 |