| NPI | 1366457855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301509860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD20106) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-03-21 |