| NPI | 1083697908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-01803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101-230954) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2023-01-31 |