| NPI | 1376859884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301103086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 105716) |
| 207R00000X Internal Medicine (Licence: MO 2010013999) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2025-10-01 |