| NPI | 1124144019 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: MI 4301085273) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301085273) | 
| Enumeration Date | 2007-03-22 | 
| Last Update Date | 2022-01-17 |