| NPI | 1245226612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 00024570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00245) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-11-16 |