| NPI | 1083676803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101011276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI JB011276) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2026-03-03 |