| NPI | 1336147602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 79569) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0451631) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 108559) | |
| 207R00000X Internal Medicine (Licence: MO 108559) | |
| 207R00000X Internal Medicine (Licence: CO DR.0071908) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MO 108559) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2025-12-16 |