| NPI | 1205862612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301064977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA c172881) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2025-08-28 |