| NPI | 1083861017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME109969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-121652) |
| 207R00000X Internal Medicine (Licence: WI 52033-20) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2022-09-27 |