| NPI | 1356458111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 333826) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 19207) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-08-02 |