| NPI | 1104887728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2005023728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.173912) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2026-07-06 |