| NPI | 1225059611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200200006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 00006) |
| 207R00000X Internal Medicine (Licence: SC 86633) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-10-24 |