| NPI | 1235128828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 42956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME72210) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2023-04-18 |