| NPI | 1366431082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D55516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 12714) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2023-11-01 |