| NPI | 1114230323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 32988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 75406) |
| 207R00000X Internal Medicine (Licence: SC LL32988) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2024-06-03 |