| NPI | 1174512149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 59509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD23853) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2025-08-07 |