| NPI | 1255326096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 51788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 33912) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2023-11-07 |